ANNALS OF MEDICINE will be used as an adjunct to antibiotics in ulcer therapy. This promises unsurpassed relief to millions of people-and consid- erable savings. A standard maintenance regimen of Zantac-the world's No.1 prescription drug, with an estimated three billion dollars in sales last year- runs about a hundred dollars a month. Over the years, a person with d. recurring ulcer might easily spend ten or fifteen thousand dollars keeping it quiet. In con- trast, a twelve-day ulcer-curing course of the antibiotics amoxicillin and metro- nidawle, which are generic drugs, would cost about twenty dollars. All told, Mar- shall estimates that an ulcer can be cured outright for six hundred and fifty dollars, including the costs of visits to a physician, antibody tests, endoscopy, and drugs. The makers of the leading acid-blocking drugs were not initially among Marshall's biggest fans. Marshall says he tried right :from the start to interest pharmaceutical firms in his findings. "I wrote a letter to all the major drug companies," he recalls. "I said, 'Look, I've got some major new advances related to ulcers, and 1'd like to tell you about them and ask for some sup- port.' They wrote back-practically a form letter-'Dear Dr. Marshall, we're very pleased to know you've got major new findings, but research funding is very tight this year, blah, blah, blah, congratu- lations, b-lah, blah, keep up the good work.' And that was about all I got." What a difference a decade makes. Now, pharmaceutIcal giants as well as univer- sity labs and small firms are scrambling to cash in on Helicobacter. Everything from new diagnostic tests to new antibiotics are in the works. Recently, Marshall says, he has helped to conduct clinical trials of new drugs, funded by Glaxo (maker of Zantac) and other major drug companies. Graham, whose research team has done important studies on antibiotic treatment of ulcers, recently told me, "Over time, within perhaps even my life- time, we should be able to eliminate ulcer dIsease from the human race." I T takes a kind of cunning for Helico- bacter pylori to fill its niche, for the adult human stomach is one of nature's most hostile habitats. Each day, the stomach normally produces about half a gallon of gastric juice, whose strong hy- drochloric acid and digestive enzymes readily tear meat and microbes apart. Gastric juice is like a binary chemical weapon-so destructive that it's consti- tuted only on the way to the target. As cells in the stomach lining secrete the raw ingredients of gastric juice into the mucus that coats the stomach lining, the in- gredients mix into an even more caustic brew, which then oozes into the cavity. There the gastric juice breaks pabulum down chemically while muscles in the stomach wall act to crush it. The visco- elastic mucus, as thick as axle grease, keeps the stomach from digesting itsel[ Once Helicobacter reaches the stom- ach, it probably does not linger out in the open cavity-a tossing sea of toxic chemicals. It heads for cover. The bacterium's helical shape seems to have been designed for speedy travel in a dense medium. Helicobacter is living torque; a microscopic Roto- Rooter, it corkscrews through the mucus. Then, instead of penetrating the cells of the stomach lin- ing, it settles in the mucus just beyond the lining. More often than not, it settles in the pylorus. No one knows why. Under the microscope, a Helicobacter infection looks like a satellite image of an armada gathered off a ragged shore. At one end of the bacterium is a cluster of long, wispy, curving flagella, which may serve as anchors. It's a graceful menace. Helicobacter possesses a vi tal defense against stomach aCId, and this adapta- tion, too, is a marvel of evolutionary de- sign. Its coat is studded with enzymes that convert urea-a waste product, vir- tually unlimited supplies of which can be found in the stomach-directly into car- bon dioxide and also into ammonia, a strong alkali. Thus Helicobacter ensconces itse]f in an acid-neutralizing mist. In like fashion, it generates another antacid- bicarbonate, as in Alka-Seltzer. A Helicobacter infection that estab- lishes itself succeeds largely because the immune system can't reach it. In response to a Helicobacter invasion, immune-system cells in the bone marrow produce white blood cells, killer cells, and other microbe destroyers, and those float through the bloodstream to the very edge of the stom- ach lining-and go no farther, because the lining holds them back. The Helico- bacter, hovering in the mucus, are out of range. And yet the immune system sends reinforcements. Killer cells pile up, gorg- ing the stomach lining; permanently alerted, seldom engaged, the killers be- come trigger-happy. 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